One of my colleagues found a nice gallbladder. I took some pictures of it after my shift was over-clearly I’m getting a bit obsessed here. It illustrates a number of findings suggestive of cholecystitis.

There are a number of views here. Some from under the right ribs anteriorly, some from through the chest wall and some from the RUQ while the patient is lying on their left side.

The first thing to note (once you find the GB) is whether the GB is specifically tender. This is subjective and takes a bit of care. If you can’t find the gallbladder, try asking for a deep breath, looking through the right ribs in various orientations and lying the patient on the left side so the GB tends to fall forward.

If the GB isn’t tender you likely don’t have to worry about it. If it is (or you’re strongly suspicious of GB pathology), try looking for stones (and shadows), particularly in the neck.

I’ve found stones often very easy to overlook, especially small ones that sink to the “bottom”.